A federal judge on Friday blocked Kentucky’s closely watched plan to require many Medicaid recipients to work, volunteer or train for a job as a condition of coverage.
The state had been poised to start carrying out the new rules next week and to phase them in fully by the end of this year.
Judge James E. Boasberg of Federal District Court for the District of Columbia, an Obama appointee, ruled that the Trump administration’s approval of the plan had been “arbitrary and capricious” because it had not adequately considered whether the plan would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.”
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In a court case filed by Texas and 19 other states, the Justice Department said in a brief on Thursday that the requirement for people to have insurance — the individual mandate — was unconstitutional.
If that argument is accepted by the federal court, it could eviscerate major parts of the Affordable Care Act that remain in place.
A definitive court ruling could be months away and appeals of any decision could take many more months, during which the law is likely to stay in effect.
The Obama administration said Tuesday that 11.7 million Americans now have private health insurance through federal and state marketplaces, with 86 percent of them receiving financial assistance from the federal government to help pay premiums.
About three-fourths of people with marketplace coverage — 8.8 million consumers — live in the 37 states served by HealthCare.gov, the website for the federal insurance exchange. The other 2.9 million people are in states that created and operate their own exchanges.
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The Trump administration said on Tuesday that 11.8 million people had signed up for health insurance through the Affordable Care Act marketplaces for 2018 — roughly 400,000 fewer than last year. Virtually the entire decrease came in the 39 states that use the marketplace run by the federal government, HealthCare.gov. In the 11 states that sell coverage for the ACA through their own marketplaces, enrollment remained the same as last year.
The Trump administration rejected on Thursday Idaho’s plan to allow the sale of stripped-down, low-cost health insurance violates the ACA. The 2010 statute “remains the law, and we have a duty to enforce and uphold the law,” Seema Verma, the administrator of the federal Centers for Medicare and Medicaid Services, said in a letter to the governor of Idaho, C.L. Otter. While rejecting Idaho’s plan in its current form, Ms. Verma encouraged the state to keep trying, and she suggested that, “with certain modifications,” its proposal might be acceptable.
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Gwen Hurd got the letter just before her shift at the outlet mall. Her health insurance company informed her that coverage for her family of three, purchased through the Affordable Care Act marketplace, would cost almost 60 percent more this year — $1,200 a month.
She and her husband, a contractor, found a less expensive plan, but at $928 a month, it meant giving up date nights and saving for their future. Worse, the new policy required them to spend more than $6,000 per person before it covered much of anything.
“It seems to me that people who earn nothing and contribute nothing get everything for free,” said Ms. Hurd, 30. “And the people who work hard and struggle for every penny barely end up surviving.”
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Alex Azar, the new secretary of health and human services, said Thursday that he would closely scrutinize a plan by Idaho to allow the sale of insurance that does not comply with the Affordable Care Act, an early test of how he will enforce a law he opposes. But he said it was too early to know what action he might take. “We’ll be looking at that very carefully and measure it up against the standards of the law,” Mr. Azar said at a hearing of the Senate Finance Committee. The plan presents Mr. Azar with a choice that he could face frequently in his new job: whether to try to shore up the health law or to “let Obamacare fail.”
People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states. “Members have difficulty finding–and in many cases cannot find–medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.
“People signed up for insurance and they ‘discovered there were no doctors,”’said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.
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The budget deal in Congress is billed as a measure to grant stability to a government funding process that has lurched from crisis to crisis — but it is also stuffed with provisions that will broadly affect the nation’s health care system, like repealing an advisory board to curb Medicare spending and funding community health centers. Among the more significant provisions is one that would eliminate a powerful 15-member panel, known as the Independent Payment Advisory Board, created by the ACA to control the rising costs of Medicare. The board was to recommend specific savings if Medicare spending per beneficiary was projected to grow faster than certain benchmarks. Congress could have stepped in to block the recommendations, but they did not need congressional approval to take effect. The power of the board gave pause to politicians in both parties, and health care providers and some advocates for Medicare beneficiaries said it could threaten patients’ access to care.
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Congress is apparently not done cutting taxes, even after passing a $1.5 trillion tax overhaul last year.
The deal struck by Democrats and Republicans on Monday to end a brief government shutdown contains $31 billion in tax cuts, including a temporary delay in implementing three health-care-related taxes.
Those delays, which enjoy varying degrees of bipartisan support, are not offset by any spending cuts or tax increases, and thus will add to a federal budget deficit that is already projected to increase rapidly as last year’s mammoth new tax law takes effect.
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